Under both the Medicare and Medicaid programs, the government will only pay for care that is reasonable and necessary for the diagnosis or treatment of illness or injury.  Before any healthcare provider is paid for any health care services, treatments, tests, devices or pharmaceuticals provided to patients whose care is paid for by these government programs, the provider must certify that the treatment or service was medical necessary.  When a healthcare provider submits claims for payment to a government-funded healthcare program for care that is not medically necessary, it may give rise to a False Claims Act violation and a whistleblower lawsuit.

Unfortunately, there are healthcare providers who will order treatment or perform tests and procedures that are not medically necessary in order to bill government healthcare programs for a patient’s supposed care.  When that happens, the government ends up paying for frivolous or unnecessary procedures, tests and devices.  This is Medicare and Medicaid fraud but it also subjects patients to unnecessary risk and potential harm.  False Claims Act cases involving lack of medical necessity are an especially important kind of whistleblower case because of the high risk of patient harm that goes along with a healthcare provider ordering or performing unnecessary medical care.

If you believe someone has knowingly been ordering or performing unnecessary medical care involving Medicare or Medicaid patients and you would like more information about how this may be the grounds for bringing a Medicare or Medicaid whistleblower lawsuit, the qui tam lawyers at Keller Grover LLP can help you.  The whistleblower lawyers at Keller Grover understand qui tam litigation, including the whistleblower protection provisions, and strive to achieve the best possible results for their clients.